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DSH330180AX SAMARITAN HOSPITAL (Active)
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Main Details
Name
SAMARITAN HOSPITAL
Subdivision Name
Anticoagulation Clinic - AMH Campus - Anticoagulation Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330180AX
Medicare Provider Number
330180
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/13/2020
Participating Start Date
1/1/2021
Participating Approval Date
11/3/2020
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Samaritan Hospital of Troy NY
Lori Santos, CFO
(518) 525-5537
Primary Contact
Samaritan Hospital
Dario Pantano, Pharmacy Manager
(518) 271-3454
Addresses
Street Address
600 Northern Blvd 1st Floor
Albany, NY 12204
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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